Research Progress on the Pathogenesis of Primary Enuresis in Children

Nocturnal enuresis(NE)is a common disease in children,commonly known as bedwetting.The International Children's Continence Society(ICCS)defines intermittent urinary incontinence during nighttime sleep in children aged 5 and above as enuresis.Enuresis can be divided into two types:primary nocturnal enuresis(PNE)and secondary nocturnal enuresis(SNE).PNE refers to nocturnal urinary control ability that has never been achieved for more than 6 months in children aged 5 and above with enuresis;SNE refers to the recurrence of enuresis symptoms after a period of more than 6 months of continuous nocturnal urinary control ability.SNE is relatively rare in clinical practice and is often caused by sudden stress events or other diseases such as snoring.Its pathogenesis and treatment are different from PNE.PNE is a multifactorial disease related to genetics,and its pathogenesis is not fully understood.There are not many research and review articles on its pathogenesis.In recent years,there has been significant progress in the epidemiology and pathogenesis of PNE.The following is a summary.

Phallic rubber band application to prevent enuresis unusual cause of urethral stricture in a child:A case report

BACKGROUND Urethral stricture is the abnormal narrowing of the urethra due to spongiofibrosis.The established aetiological factors for urethral stricture abound in our environment.However,the application of a penile rubber band to prevent enuresis thereby causing this pathology is not a familiar occurrence.Patients with enuresis can suffer psycho-social challenges and trauma,especially for a child due to peer stigmatization.This has a great impact on the child's psyche and may affect even his performance at school.The aim of this paper is to highlight the psychosocial impact and management challenges of a child with enuresis(nocturnal urinary incontinence).CASE SUMMARY This is the case of a 10-year-old boy who presented with a history of nocturnal urinary incontinence since birth and lower urinary tract symptoms(LUTS)for 3 years culminating in chronic urinary retention.He maintained a normal urge to micturate and continent of urine during the daytime before the onset of LUTS.He had an antecedent longstanding history of tying a rubber band to the penile shaft mostly before going to the bed at night to prevent enuresis due to his peer stigmatization.He was acutely ill-looking,with distended suprapubic region.The phallus and scrotum were enlarged and oedematous with a circumferential proximal penile shaft scar and ventral penile shaft urethrocutaneous fistula.He was diagnosed to have complete short segment bulbopenile stricture and right ectopic ureter.He subsequent had augmented anastomotic urethroplasty and bilateral non-refluxing ureteroneocystostomy at different sitting.CONCLUSION The adherence to surgical principles of urethral stricture and enuresis management where surgically correctable in a child is associated with the resolution of enuresis and social reintegration.

The post-treatment effects of enterobiasis on the occurrence of enuresis among children in Calabar,Nigeria

Objective:To investigate the relationship between enterobiasis and enuresis before and after albendazole therapy among 632 children,aged,5-14 years,in Calabar,Nigeria.Methods:The scotch tape(cellotape) technique was used for the detection of eggs of Enterobius vermicularis (E.vermicularis) while questionnaire-based interviews were used for screening for anal itching and/or enuresis among study participants.All subjects found positive for Enterobius infection as confirmed by the presence of eggs and those with persistent anal itching(both enuretic and nonenuretic) were treated with 400 mg of albendazole given as a single dose.The treated subjects were re-assessed post-treatment to ascertain whether they were cured and also to determine their enuretic status(for the entireties).Results:The overall prevalences of Enterobius infection, anal itching,and enuresis prior to albendazole therapy were 6.8%,42.9%,and 35.6%respectively. There was no statistically significant difference in the prevalence of these parameters by the socio-economic class of subjects(P = 0.462,P - 0.647,and P = 0.610,respectively).The pretreatment prevalences of enuresis among Enterobius and anal itching-positive subjects were 53.5%and 49.8%,respectively versus 34.3%and 24.9%,respectively among their negative counterpart(P = 0.012 and P 【 0.001,respectively).Four(20%) out of the 20 enuretic children found Enterobius egg-negative after albendazole therapy were equally cured while 8(40%) had reduction of their enuresis,thus giving a total resolution rate of 60%.Similarly,64.2%resolution (25%cure and 32.8%reduction) of enuresis was observed amongst 120 anal itching-cured/ enuretic children.Enuretic status of the Enterobius-lanal itching-uncured subjects,on the other hand,remained unchanged post-treatment.Conclusions:This study is suggestive of the involvement of E.vermicularis in the aetiology of enuresis in Calabar.Children presenting with, especially,uncomplicated enuresis should be screened for enterobiasis.

CLINICAL OBSERVATION ON 68 CASES OF ENURESIS TREATED BY MOXIBUSTION COMBINED WITH FINGER-MASSAGE METHOD

The therapeutic effect of moxibustion combined with finger-massage method was observed in 68 patients suffering from enuresis. The results showed that (1) The present therapy is effective for enuresis with cure rate of 66.18% and total effective rate of 92. 65 %; (2) The curative effects was related with the syndrome differentiation (P <0. 01), e. g. it is effective for deficiency of kidney-Yang and deficiency of Qi in lung and spleen types, but ineffective for the type of downward flow of damp-heat; (3) The therapeutic effect was also closely related with the course of disease. The shorter the course of illness lasted, the more effective the therapy was, indicating that such patients should be treated in the early stage. This method is not only comparable to other conventional acupuncture methods in respects of the cure rate and total effective rate, but is also simple to apply, safe to use, easy to be accepted by children and adverse-effect free. It is deserved to be popularized as a effective therapy for enuresis in children patients.

CLINICAL OBSERVATION ON 32 CASES OF FUNCTIONAL ENURESIS TREATED WITH ACUPUNCTURE AT BAIHUI(GV 20)

Acupuncture at Baihui（GV 20）was employed in treating 32 cases of functionalenuresis.As a result,the curative rate reached 81.25％,but that in control group of 32 cases withoutneedling Baihui point was 56.25％.There was a significant difference in statistics（P【0.05）.It indi- cates that Baihui can enhance the therapeutic effect of acupuncture on treating enuresis.

Mechanism of Xingshen Zhiyi prescription in the treatment of enuresis based on network pharmacology

Objective:To explore the mechanism of Xingshen Zhiyi Recipe(XSZYF)in the treatment of Nocturnal Enuresis(NE)based on network pharmacology.Methods:TCMSP,DrugBank databases,PubMed and CNKI were used to obtain the active ingredients and corresponding targets of XSZYF.NE targets were obtained from GeneCard and OMIM databases.Cytoscape software was used to construct a drug-disease-target network model.The analysis was performed.The protein interaction network(PPI)was constructed using the STRING database.The gene ontology functional annotation(GO)and the Tokyo Genomic Encyclopedia(KEGG)pathway enrichment analysis were performed on key targets using the DAVID online tool.Surflex docking software was used for the analysis.Docking of key active ingredients and key targets to verify the results of network analysis.Results:199 gene targets of XSZYF were obtained,and 2486 gene targets of NE.Network analysis results showed that the key targets of XSZYF for treating NE include CHRM3,CHRM2,ADRB3,etc.Involved in regulating neuroactive ligand-receptor interactions,calcium signaling pathways,etc.Conclusion:This study revealed the material basis and action mechanism of XSZYF in treating NE from the perspective of network pharmacology.

No Correlation between <i>AVPR</i>1A Promoter Polymorphisms and Prepulse Inhibition in Patients with Nocturnal Enuresis

Introduction: A correlation between AVPR1A promoter polymorphisms and prepulse inhibition (PPI) of startle reflexes has been described in healthy adults. Many children with nocturnal enuresis (NE) have a reduced PPI and treatment with desamino arginine vasopressin (dDAVP), a ligand of the arginine vasopressin receptor 1A (AVPR1A), and both improve clanical symptoms and significantly increase PPI. Methods: In 17 children (median 9.1 years, range 6.4-17.3) with NE, promoter repeats within the RS1 and RS3 regions of AVPR1A were quantified and correlated to PPI (native and age-adjusted). Results: No direct correlation was found between the number of promoter repeats at RS1 and PPI (correlation coefficient—0.240, p = 0.346) or RS3 and PPI (correlation coefficient—0.0192, p = 0.936), with no change through age-adjustment of PPI. The different RS3 length subgroups did not show differences in PPI, nor did differentiation of NE according to clinical subtype or treatment response to dDAVP show differences in the number of promoter repeats. Conclusion: The missing reproducibility of the correlation between AVPR1A promoter polymorphisms and PPI in a group with wide range of PPI suggests a more complex interaction. Therefore, further investigations are needed to analyze this very plausible interaction. Conditions with a reduced PPI, such as enuresis, schizophrenia or autism, are particularly interesting for this research.

Enuresis and sleep disordered breathing:An old and new link

The causes of nocturnal enuresis(NE) are likely multifactorial.It has been related to several(urologicalnephrological-hormonal) reasons but clear and univocal pathogenesis remains mostly undetermined.Sleep disordered breathing(SDB) is a syndrome of upper airway dysfunction that occurs during sleep and is characterized by snoring and/or increased respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility.Adenotonsillar hypertrophy is the main cause of SDB in children.To date,several studies have associated childhood NE with coexistent SDB.Adenotonsillectomy was successful for both SDB and NE in about half of patients.Unfortunately,practical consensus guidelines for the management of primary NE do not mention,or marginally concern,SDB in these children,particularly in those who have treatment resistance and comorbidities.The concerns regard the concomitant presence of two relatively frequent sleep disorders,raising the question whether they are really coincidental problems of childhood.

Better outcomes with desmopressin melt than enuretic alarm therapy in children with nocturnal enuresis during coronavirus disease 2019(COVID-19)

Objectives:This study aimed to investigate the effect of the coronavirus disease 2019(COVID-19)pandemic on the treatment of children with primary monosymptomatic nocturnal enuresis(MNE)with desmopressin melt versus an enuresis alarm.Materials and methods:This study included 56 children with primary MNE who were taking desmopressin melt or using an alarm.Their anxiety levels were evaluated using the Social Anxiety Scale for Children-Revised.For both treatment methods,data from a 3-month bedwetting diary between the third and sixth months of the pre-pandemic treatment were compared with those assessed during the same period during the pandemic.Results:Prior to the COVID-19 pandemic,the median 3-month mean frequency of MNE was 1(0-7.67)in children using desmopressin melt versus 1.33(0-6)in those using alarm treatment(p=0.095).During the COVID-19 pandemic period,the median monthly mean frequency of MNE was 1.33(0-7.33)in children using desmopressin melt versus 6(1.33-13)in those using alarm treatment(p<0.001).Conclusions:The COVID-19 pandemic and its accompanying psychological effects did not affect the treatment efficacy of desmopressin melt in children with primary MNE but did adversely affect that of enuresis alarms.

Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children

Background Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children.OSA and NE are thought to be interrelated,but the exact pathophysiological mechanisms are not yet clear.This review aims to explain the possible pathogenesis of NE in children with OSA.Date sources We have retrieved all relevant original articles from Database that have been published so far,including the prevalence studies of NE and OSA in children,sleep characteristic studies that use polysomnography (PSG) to focus on children with NE,and studies on the relationship between OSA and NE.Results Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers.This increased risk may be associated with sleep disorders,bladder instability,detrusor overactivity,nocturnal polyuria,endocrine and metabolic disorders,and inflammation.Conclusions Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA,but this remains to be confirmed by animal studies.Other causes such as oxidative stress and inflammatory responses need to be further researched.

Evaluation of a new frequency-volume chart for children with primary monosymptomatic nocturnal enuresis:a prospective,comparative study

Introduction To improve compliance with voiding diaries in children with primary monosymptomatic nocturnal enuresis(PMNE),a new modified 3-day weekend frequency-volume chart(FVC)was designed,and the compliance and validity of this modified FVC was evaluated by comparing with the International Children's Continence Society(ICCS)recommended voiding diary.Methods A total of 1200 patients with PMNE were enrolled in the study from 13 centers in China and were randomly assigned to record this modified FVC or the ICCS-recommended voiding diary.The primary outcome measure was the compliance,assessed by comparing the completing index and the quality score of diaries between two groups.The secondary outcome measure was the validity,evaluated by comparing the constituent of subtypes,micturition parameters and response rate to desmopressin.Results Among the 1200 participants enrolled in the study,447 patients completed the ICCS-recommended voiding diary and 469 completed the modified diary.The diurnal completing index and the quality score of the modified FVC group were better than those of the ICCS group.In addition,there was no significant difference between these two groups in the subtype classification,or in the response rate to desmopressin.Conclusions The modified FVC could be applied to obtain the voiding characteristics of children with PMNE as the ICCS-recommended voiding diary does and offers a reasonable and better choice for children with PMNE from the unselected population in the future.

Treatment of 43 Cases of Enuresis by Acupuncture

By classification with syndrome differentia -tion into the three patterns of deficient cold in the lower energizer, qi deficiency in the spleen and lung and damp heat in the Liver Meridian, 43 cases of enuresis were treated by puncturing Baihui (GV 20), Guanyuan (CV 4)and Sanyinjiao (SP 6). After two courses of the treatment,the results showed cure in 28 cases, improvement in 13 cases and failure in 2 cases.

Urodynamic changes in a female case of obstructive sleep apnea syndrome with enuresis： 7 years＇ follow-up

Obstructive sleep apnea syndrome （OSAS） is characterized by repetitive upper airway occlusion resulting in apnea lasting 10 seconds or more. Clinical manifestations include snoring, daytime somnolence, intellectual deficiency, sexual impotence, and nocturnal polyuria. Enuresis associated with OSAS is suggested to be more common in children than in adults） In children, removal of upper airway obstruction by surgical intervention （tonsillectomy and/or adenoidectomy） leads to a significant decrease in or complete cure of enuresis. Although a great deal has been written concerning aduk enuresis,

Clinical Observation of 82 Cases of Enuresis Treated by Ginger-partitioned Moxibustion plus Cupping Therapy

Purpose: To observe the clinical therapeutic effect in the treatment of enuresis by ginger-partitioned moxibustion plus cupping therapy. Methods: Ginger-par -titioned moxibustion was applied on Guanyuan (CV 4)and bilateral Zusanli (ST 36) and cupping therapy was applied on Shenque (CV 8) in the treatment of 82 cases of enuresis, in comparison with 76 cases treated by Chinese herbal medicine. Results: The effective rate was 84.1% in the treatment by ginger-partitioned moxibustion plus cupping therapy and was 64.5% in the treatment by Chinese herbal medicine. Conclusion: Ginger-partitio -ned moxibustion plus cupping therapy was better than Chinese herbal medicine in the treatment of enuresis (P ＜0.05).

Treatment of Enuresis by Needling Zuyunganqu in 135 Cases

Treatment of 100 cases of enuresis by needling scalp Zuyunganqu (foot motor-sensory area), the effective rate was 96.3%. Since acupuncture at head,patients were willing to accept.

Treatment of 36 Cases of Infantile Enuresis by Acupuncture

Treated 36 cases of infantile enuresis by acupuncturing Zuyunganqu (Foot Motor Sensory Area),Guanyuan (CV 4), Qihai (CV 6), Zhongwan (CV 12),Zusanli (ST 36), Yinlingquan (SP 9), Pishu (BL 20),Weishu (BL 21) and Shenshu (BL 23). After two courses,29 cases were cured, 5 cases were improvement and 2cases were no effect.

Cutaneaous Myiasis: A Rare Tropical Disease in an 11-Year-Old Girl

Myiasis is the infestation of live human and vertebrate animals with maggots that feed on the host’s dead or living tissue, depending on the life cycle of the fly. It is a rare condition and often misdiagnosed. Tropical and subtropical regions of the world are commonly affected. The aim of this case report is to share this uncommon cutaneous condition with health workers and also remind them of its common symptoms and signs such that its diagnosis is not missed. An 11-year-old girl presented with a nine-day history of itchy rash involving mainly the trunk and upper arms which were found to be cutaneous Myiasis. Cutaneous Myiasis can cause miserly to the affected individual due to its symptoms, yet it can be prevented with good environmental and personal hygiene. Diagnosis and treatment are cheap and effective.

Case report: Desmopressin and somnambulism

Background: Nocturnal enuresis is caused by a mismatch between nocturnal urine production and bladder capacity. Together with a presumed decreased arousability, this results in an inability to awaken in response to a full bladder. According to recent findings, a disrupted sleep might play a role in the pathophysiology of enuresis. Case: A 7-year-old boy was diagnosed with primary nocturnal enuresis caused by nocturnal polyuria and a concomitant parasomnia, somnambulism. A polysomnographic study was performed before treating the nocturnal enuresis with the oral lyophylisate formulation of desmopressin (melt). After 1 day of treatment, both nocturnal enuresis and somnambulism disappeared. Treatment was ceased after six months. One week later, the child started to produce more urine and redeveloped nocturnal polyuria. Somnambulism reappeared followed by nocturnal enuresis two weeks later. The same treatment protocol was started up, resulting in disappearance of both nocturnal enuresis and somnambulism. Conclusion: This case report documents the beneficial effect of desmopressin melt on both nocturnal enuresis, caused by nocturnal polyuria, and a concomitant parasomnia in particularly somnambulism.

The Effect of Neurofeedback Therapy in Primary Enuretic Children

Introduction:?Enuresis is one of the most common psychiatric disorders in children. Classical?treatments for primary enuretic children are conditioning (Bell and Pad method, and drug therapy). Neurofeedback is a kind of conditioning by changing amplitudes of brain waves. Method: Three?groups of 10 enuretic children were selected randomly. All three groups took imipramine. The?first group also took neurofeedback sessions with protocol of enhancement of?β/θ?wave ratio in occipital zone. The second group took non-real neurofeedback sessions beside the drug. The third?group just took the drug. Result:?All three groups showed significant remission (P < 0.0001) after treatment and a three-month follow-up. Conclusion:?Neurofeedback by this protocol was not any more efficient than imipramine therapy by itself.

Chinese Medicine and the Surgeon

The surgeon aims at a direct,complete removal of the pathology.In spite of the modern advancements of imaging facilities and precision instrumentations,unsatisfactory results and recurrences are not uncommon.This paper provides a general review of the four specific areas in surgery that would benefit from Chinese medicine.Extensive searches were made on four surgical areas based on available English language journals,viz.low-back pain,chronic ulcers,renal calculus,and enuresis in children,in the past 10 years.The quoted communications are mainly related to clinical evidences,while a smaller number of crucial laboratory reports are also included.Low-back paln,a most frequent orthopaedic problem,would benefit from acupuncture treatment.Chronlc leg ulcers could achieve better results of healing using herbal supplements.Problems of renal stones,besides the conventional methods of removal,could be further supplemented with herbal drinks that aim at prevention of recurrences.Enuresis in children,an untreatable common condition,may respond well to acupuncture.Surgeons should keep an open mind.In case of difficulties,they could seriously consider options of traditional treatment.